Clinical Efficacy of Prostate Artery Embolization in Men with Small Volume Prostates

Purpose: Prostatic artery embolization (PAE) has been demonstrated to be clinically effective for men with large prostates and is now an accepted therapy per the American Urologic Association (AUA) Guidelines for this patient population. Very little has been published, however, on the efficacy of PAE in men with “small” volume prostates (i.e. volume ≤ 60cc) {1}. This study aims to examine the clinical outcomes of prostate artery embolization (PAE) in patients with “small” volume prostates.

Materials and Methods: This is a single center, single operator, retrospective review of 108 men aged 46-83 years old with prostates volume ≤ 60 cc who underwent PAE between January 2018 – September 2025. Baseline International Prostate Symptom Score (IPSS)/ quality of life (QoL) score and were recorded at baseline, 6 and 12 weeks, 6 months and annually until 4 years post PAE. Baseline prostate volume (PV) and reduction at 6 and 12 weeks was also reported. Clinical success after PAE was defined as an IPSS reduction of at least 25% from baseline and an absolute score ≤ 15 points, and a reduction of QoL of at least 1 point from baseline score and absolute score ≤ 3 points. Technical success was defined as at least unilateral embolization to stasis. Adverse events were graded according to CTCAE criteria.

Results: Technical success was 98% (n=106) and bilateral embolization was performed in 82% (n=89) of cases. Median follow up time was 12 weeks. Baseline IPSS/Qol were 19.1/4.0 (range 2-35/2-6) and PV was 42.2 cc (range 14.2-60 cc). Clinical success was achieved in 78% of patients (n=71). PV reduction at 6 and 12 weeks was 28% (n=60) and 30% (n=36) p< .001. IPSS/QoL improvement at 6 and 12 weeks, 6 months, and 1, 2, 3, and 4 years was 9.7, 10.8, 7.8, 6.9, 6.9, 8.5, 3.5, and 2.0, 2.2, 1.6, 1.6, 1.0, 0.5, and 1.3 (p< .003 except IPSS at 4 years and QoL at 3 years where p > .05). One patient experienced CTCAE grade 4 event during the procedure – cerebrovascular accident with headache. Five patients experienced a CTCAE grade 3 event – one with a right penile ulcer managed conservatively and four with acute urinary retention requiring foley catheter placement. One of these patients also had a urinary tract infection requiring IV antibiotics.

Conclusion: Very little has been reported regarding the clinical efficacy of PAE in small prostates. This study demonstrates that PAE is a safe and effective treatment option for patients with LUTS and small prostates. In addition, overall clinical success is comparable though slightly lower than compared to patients with enlarged prostates.